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An assessment of the health care system for diabetes in Addis Ababa, Ethiopia
Yeweyenhareg Feleke, Fikre Enquselassie
Ethiopian Journal of Health Development , 2005,
Abstract: Background: During the past decade, diabetes mellitus has emerged as an important clinical and public health problem through out the world. WHO estimated the number of cases of diabetics in Ethiopia to be about 800,000 in 2000, and projected that it would increase to about 1.8 million by the year 2030. Care for diabetic patients may require close and sustained support from a health care team, adequate financial resources, and advanced patient knowledge and motivation. In this respect, there is lack of information in the country. Objective: This study was conducted with the aim of assessing the characteristics of the health care system for diabetic patients, how diabetic patients are cared for including medical care and adequacy of facilities for the prevention of complications and outcomes at primary health care and secondary health care levels. Methods: An assessment of the characteristics of the health care system (structure) for diabetic patients was conducted in 21 health centres (primary health care level) and 5 regional hospitals (secondary health care level) in Addis Ababa. Furthermore, a total of 106 diabetic patients drawn from six out of the 21 health centres and another 123 diabetic patients drawn from three of the six hospitals were consecutively interviewed. Results: All the Regional hospitals and one of the health centres were running established diabetic referral clinics. Similarly, a lack of professionals was observed in all the health institutions in general and the health centres, in particular. Only 21% of patients had access for blood glucose monitoring at the same health institutions. The emphasis given for diabetic education (24%) was less than expected. Only 11 (5%) of diabetic patients were able to do self blood glucose monitoring at home. Fifty one percents of patients didn't have urine analysis, BUN, creatinine and lipid profile in the previous 1-2 years. None of diabetic patients had haemoglobin Alc (HbA1c) determination. Nearly 75% of the patients required admissions directly or indirectly due to uncontrolled diabetes. About 87% of the diabetics had regular follow ups at their respective health centres and hospitals. Hypertension (34%), diabetes related eye disease (33%) and renal disease (21%) were the major associated illnesses observed among the diabetics. Sixty-six patients (23%) had a total of about 131 admissions. Conclusion: Although there is a well-established health infrastructure for diabetics care in Addis Ababa, the diabetic care is below the acceptable standard. The finding of this study may, thus, help to clarify issues related to potential changes in the health care system dealing with diabetes and for strengthening the referral system for diabetes health care. Ethiopian Journal of Health Development Vol. 19(3) 2005: 203-210
Prevalence of prenatal zinc deficiency and its association with socio-demographic, dietary and health care related factors in Rural Sidama, Southern Ethiopia: A cross-sectional study
Samson Gebremedhin, Fikre Enquselassie, Melaku Umeta
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-898
Abstract: A community based, cross-sectional study was conducted in Sidama zone in January and February 2011. Randomly selected 700 pregnant women were included in the study. Data on potential determinants of ZD were gathered using a structured questionnaire. Serum zinc concentration was measured using Atomic Absorption Spectrometry. Statistical analysis was done using logistic regression and linear regression.The mean serum zinc concentration was 52.4 (+/-9.9) μg/dl (95% CI: 51.6-53.1 μg/dl). About 53.0% (95% CI: 49.3-56.7%) of the subjects were zinc deficient. The majority of the explained variability of serum zinc was due to dietary factors like household food insecurity level, dietary diversity and consumption of animal source foods. The risk of ZD was 1.65 (95% CI: 1.02-2.67) times higher among women from maize staple diet category compared to Enset staple diet category. Compared to pregnant women aged 15-24 years, those aged 25-34 and 35-49 years had 1.57 (95% CI: 1.04-2.34) and 2.18 (95% CI: 1.25-3.63) times higher risk of ZD, respectively. Women devoid of self income had 1.74 (95% CI: 1.11-2.74) time increased risk than their counterparts. Maternal education was positively associated to zinc status. Grand multiparas were 1.74 (95% CI: 1.09-3.23) times more likely to be zinc deficient than nulliparas. Frequency of coffee intake was negatively association to serum zinc level. Positive association was noted between serum zinc and hemoglobin concentrations. Altitude, history of iron supplementation, maternal workload, physical access to health service, antenatal care and nutrition education were not associated to zinc status.ZD is of public health concern in the area. The problem must be combated through a combination of short, medium and long-term strategies. This includes the use of household based phytate reduction food processing techniques, agricultural based approaches and livelihood promotion strategies.Zinc is one of the essential trace elements and vital micronut
Independent and Joint Effects of Prenatal Zinc and Vitamin A Deficiencies on Birthweight in Rural Sidama, Southern Ethiopia: Prospective Cohort Study
Samson Gebremedhin, Fikre Enquselassie, Melaku Umeta
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0050213
Abstract: Background The effects of prenatal Zinc Deficiency (ZD) and Vitamin A Deficiency (VAD) on birthweight are controversial and their interaction has not been investigated. Objective To assess the independent and interaction effects of prenatal zinc and vitamin A deficiencies on birthweight in rural Sidama, Southern Ethiopia. Methodology A community-based prospective cohort study design was employed. Six hundred fifty pregnant women in their second or third trimester were randomly selected and their serum zinc and retinol concentrations were determined. About 575 subjects were successfully followed until delivery and birthweight was measured within 72 hours after delivery. The association between the exposures and birthweight was examined using log-binomial and liner regression analyses. Potential interaction between ZD and VAD was examined using Synergy Index (SI). Results The mean birthweight (± standard deviation) was 2896 g (±423). About 16.5% (95% CI: 13.5–19.6%) of the babies had Low Birthweight (LBW). Prenatal ZD and VAD were not significantly associated to LBW with Adjusted Relative Risk (ARR) of 1.25 (95 CI: 0.86–1.82) and 1.27 (95% CI: 0.86–1.87), respectively. Stratified analysis on the basis of gestational trimester showed that the occurrence of the deficiencies neither in the second nor third trimester were associated to LBW. The deficiencies did not show synergetic interaction in causing LBW [SI = 1.04 (95% CI: 0.17–6.28)]. Important risk factors of LBW were maternal illiteracy [RR = 1.80 (95% CI: 1.11–2.93)], female sex of the newborn [RR = 1.79 (95% CI: 1.19–2.67)], primiparity [RR = 1.16 (95% CI: 1.02–1.35)], short maternal stature [RR = 1.63 (95% CI: 1.06–2.51)] and maternal thinness [RR = 1.52 (95% CI: 1.03–2.25)]. In the linear regression model, elevated CRP was also negatively associated to birthweight. Conclusion LBW is of public health significance in the locality. The study did not witness any independent or interaction effect of prenatal ZD and VAD on birthweight.
Risk Factors for Multidrug-Resistant Tuberculosis and Characteristics of Cases: A Case-Control Study of Patients Attending ALERT General Hospital in Addis Ababa, Ethiopia  [PDF]
Ezra Shimeles, Fikre Enquselassie, Melaku Tilahun, Alemayehu Mekonnen, Getachew Wondimagegn, Tsegaye Hailu, Abraham Aseffa
Open Journal of Respiratory Diseases (OJRD) , 2019, DOI: 10.4236/ojrd.2019.91001
Abstract: Background:Tuberculosis remains a major public-health problem in the world, despite several efforts to improve case identification and treatment. Particularly multidrug-resistant tuberculosis is becoming a major threat to tuberculosis control programs in Ethiopia which seriously threatens the control and prevention efforts and is associated with both high death rates and treatment costs. Methods: A case-control study was conducted to assess risk factors and characteristics of MDR-TB cases at ALERT Hospital, Addis Ababa, Ethiopia, where cases were 167 MDR-TB patients, while controls were newly diagnosed and bacteriologically confirmed pulmonary TB cases of similar number, who were matched by sex and age of 5-years interval. Results: The socio-demographic characteristics of the participants indicated that majority (53.3%) were males and 46.7% females; a little over half of cases (55.1%) were in the age group 26 - 45 years, whereas 46.7% of controls were in this age group. According to the multivariable logistic regression analysis, previous history of hospital admission was the only factor that was identified as predictor which increased risk to develop MDR-TB by almost twenty times (AOR = 19.5; 95% CI: 9.17 - 41.62) and P-value of <0.05. All other studied factor such as being unemployed, family size, having member of household member with TB, and history of visiting hospital in past 12 months etc., didn’t show any statistically significant association. Conclusion: The study identified previous history of hospital admission as independent predictors for the occurrence of MDR-TB, while other studied variables didn’t show any strong association. The findings added to the pool of knowledge emphasizing the need for instituting strong infection control practice at health care facilities to prevent nosocomial transmission of MDR-TB.
Fertility awareness and post-abortion pregnancy intention in Addis Ababa, Ethiopia
Yilma Melkamu, Fikre Enquselassie, Ahmed Ali, Hailemichael Gebresilassie, Lukman Yusuf
Ethiopian Journal of Health Development , 2003,
Abstract: Background: Abortion related complications are known to be among the leading causes of maternal mortality and disabilities in developing countries. Objectives: The aim of the study was to assess the knowledge of post-abortion patients, regarding return of fertility and pregnancy intentions. Methods: Cross sectional study was undertaken in four government hospitals in Addis Ababa, Ethiopia from November 2001 to February 2002. Four hundred post-abortion cases were interviewed at the point of their discharge to get information on their fertility awareness and future pregnancy intentions. Results: Seventeen percent of the respondents who reported that the pregnancies were unwanted admitted some kind of interference with the pregnancy. Thirty six percent reported that they were assisted at clinics for inducing the abortion. Overall about 82% of them reported not having a plan to become pregnant in three months period following the abortion. Seventy three percent of them were not able to tell the time at which they could become pregnant if involved in sexual intercourse after the present abortion. Conclusion: This study revealed the urgent demand for quality services that should include education and provision of family planning counseling and methods. Ethiop.J.Health Dev. 2003;17(3):167-174
Parent-young people communication about sexual and reproductive health in E/Wollega zone, West Ethiopia: Implications for interventions
Tesso Dessalegn W,Fantahun Mesganaw A,Enquselassie Fikre
Reproductive Health , 2012, DOI: 10.1186/1742-4755-9-13
Abstract: Objectives This study aims at examining parent-young people communication about sexual and reproductive health related topics and factors associated with it from both young people’s and parents’ perspectives. Methods A cross-sectional study was conducted among 2,269 young people aged 10–24 years in Nekemte town and semi urban areas, western Ethiopia. Chi-square and multivariate logistic regression analyses were conducted using SPSS for windows version 16. The qualitative data was coded, and categorized in to emerging themes using the open code software version 3.4. Result About a third of young people-32.5% (32.4% of females and 32.7% males) engaged in conversation about sexual and reproductive health topics with their parents/parent figures during the last six months. In logistic regression analyses, young people who were aged 15–19 years were more likely to report parent-communication compared to the other age groups (AOR = 1.57; 95%CI = 1.26-1.97). Female young people are more likely to discuss with their mothers, (AOR = 1.89, 95% CI = 1.13-3.2), sister (AOR = 2.16, 95% CI = 1.19-3.9) and female friends (AOR = 11.7, 95% CI = 7.36-18.7) while males are more likely to discuss with male friends (AOR = 17.3, 95%CI = 10-4-28.6). Educated young people were more likely to parent-communicate(AOR = 1.70, 95%CI = 1.30-2.24). Fear of parent, cultural taboos attached to sex, embarrassments, and parents’ lack of knowledge related to sexual and reproductive health were found to be barriers for parent communication. Parent-communication takes place not only infrequently but also in warning, & threatening way. Conclusion Parent-young people communication about sexual health is occurring rarely in the family and bounded by certain barriers. Programmes/policies related to young people’s reproductive health should address not only individual or behavioral factors but also cultural and social factors that negatively influence parent-communication about reproductive health.
Has oral fluid the potential to replace serum for the evaluation of population immunity levels?: a study of measles, rubella and hepatitis B in rural Ethiopia
Nokes D. James,Enquselassie Fikre,Nigatu Wondatir,Vyse Andrew J.
Bulletin of the World Health Organization , 2001,
Abstract: OBJECTIVE: To assess the suitability of using oral-fluid samples for determining the prevalence of immunity to vaccine-preventable infections. METHODS: Paired blood and oral-fluid samples were obtained from 853 individuals of all ages from a rural Ethiopian community. Oral fluid around the gums was screened for measles- and rubella-specific antibodies using enhanced IgG antibody capture (GAC) enzyme-linked immunosorbent assays (ELISAs), and for anti-HBc antibodies using a prototype GACELISA. IgG antibodies in serum to measles, rubella and HBc were determined using commercial ELISAs. FINDINGS: Relative to serum, oral fluid assay sensitivity and specificity were as follows: 98% and 87% for measles, 79% and 90% for rubella, and 43% and 87% for anti-HBc. These assay characteristics yielded population prevalence estimates from oral fluid with a precision equal to that of serum for measles (all ages) and rubella (ages <20 years). CONCLUSION: Our results suggest that oral fluid could have the potential to replace serum in IgG antibody prevalence surveys. Further progress requires assessment of variation in assay performance between populations as well as the availability of standardized, easy to use assays.
Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia
Derege Kebede, Atalay Alem, Getnet Mitike, Fikre Enquselassie, Frehiwot Berhane, Yigeremu Abebe, Reta Ayele, Wuleta Lemma, Tamrat Assefa, Tewodros Gebremichael
BMC Public Health , 2005, DOI: 10.1186/1471-2458-5-109
Abstract: A probabilistic national sample of 20,434 in-school and out-of-school youths aged between 15 and 24 years of age was selected and interviewed regarding their sexual behavior and substance use.Over 20% of out-of-school youth had unprotected sex during the 12-month period prior to interview compared to 1.4% of in-school youth. Daily Khat intake was also associated with unprotected sex: adjusted OR (95% CI) = 2.26 (1.92, 2.67). There was a significant and linear association between alcohol intake and unprotected sex, with those using alcohol daily having a three fold increased odds compared to those not using it: adj. OR (95% CI) = 3.05 (2.38, 3.91). Use of substances other than Khat was not associated with unprotected sex, but was associated with initiation of sexual activity: adj. OR (95% CI) = 2.54 (1.84, 3.51).A substantial proportion of out-of-school youth engage in risky sex. The use of Khat and alcohol and other substances is significantly and independently associated with risky sexual behaviour among Ethiopian youths.Over 6% of Ethiopia's adult population is believed to be HIV positive. It is estimated that a large proportion of new infections occur in people aged 25 years or younger. As is the case elsewhere in Africa, transmission is almost exclusively through heterosexual contact [1], although parenteral transmission through injections account for some infections. Postponement of sex, adoption of safe sex practices, including protected sex, and prevention of parenteral transmission are the cornerstones of national and international HIV/AIDS control strategies[2]. Surveys have indicated a generally high level of awareness of HIV/AIDS[3], and increased condom use in the Ethiopian population[4]. Substance abuse is generally believed to be one of the associated factors for sexual risk behaviour in HIV transmission. Hard drugs like heroin and cocaine are very rarely available in Ethiopia. However, khat, a locally produced psycho-stimulant is commonly and widely u
Spatial Distribution of Podoconiosis in Relation to Environmental Factors in Ethiopia: A Historical Review
Kebede Deribe, Simon J. Brooker, Rachel L. Pullan, Asrat Hailu, Fikre Enquselassie, Richard Reithinger, Melanie Newport, Gail Davey
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0068330
Abstract: Background An up-to-date and reliable map of podoconiosis is needed to design geographically targeted and cost-effective intervention in Ethiopia. Identifying the ecological correlates of the distribution of podoconiosis is the first step for distribution and risk maps. The objective of this study was to investigate the spatial distribution and ecological correlates of podoconiosis using historical and contemporary survey data. Methods Data on the observed prevalence of podoconiosis were abstracted from published and unpublished literature into a standardized database, according to strict inclusion and exclusion criteria. In total, 10 studies conducted between 1969 and 2012 were included, and data were available for 401,674 individuals older than 15 years of age from 229 locations. A range of high resolution environmental factors were investigated to determine their association with podoconiosis prevalence, using logistic regression. Results The prevalence of podoconiosis in Ethiopia was estimated at 3.4% (95% CI 3.3%–3.4%) with marked regional variation. We identified significant associations between mean annual Land Surface Temperature (LST), mean annual precipitation, topography of the land and fine soil texture and high prevalence of podoconiosis. The derived maps indicate both widespread occurrence of podoconiosis and a marked variability in prevalence of podoconiosis, with prevalence typically highest at altitudes >1500 m above sea level (masl), with >1500 mm annual rainfall and mean annual LST of 19–21°C. No (or very little) podoconiosis occurred at altitudes <1225 masl, with annual rainfall <900 mm, and mean annual LST of >24°C. Conclusion Podoconiosis remains a public health problem in Ethiopia over considerable areas of the country, but exhibits marked geographical variation associated in part with key environmental factors. This is work in progress and the results presented here will be refined in future work.
Leadership in strategic information (LSI) building skilled public health capacity in Ethiopia
Italia V Rolle, Irum Zaidi, Jennifer Scharff, Donna Jones, Aynalem Firew, Fikre Enquselassie, Ashenafi Negash, Negussie Deyessa, Getnet Mitike, Nadine Sunderland, Peter Nsubuga
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-292
Abstract: Trainees' skill sets increased in descriptive and analytic epidemiology, surveillance, and monitoring and evaluation (M and E). Data from the evaluation indicated that the course structure and the M and E module required revision in order to improve outcomes. Additionally, the first cohort had a high attrition rate. Overall, trainees and key stakeholders viewed LSI as important in building skilled capacity in public health in Ethiopia.The evaluation provided constructive insight in modifying the course to improve retention and better address trainees' learning needs. Subsequent course attrition rates decreased as a result of changes made based on evaluation findings.The United States (U.S.) President's Emergency Plan for AIDS Relief (PEPFAR), implemented in 2003, is a significant undertaking by the U.S. government to prevent and treat HIV-infected persons in developing countries [1]. Strategic Information (SI) is an essential element of PEPFAR that ensures quality data are used to guide programs supported by this initiative. Surveillance, monitoring and evaluation (M and E), health management information systems, planning, and reporting are the core components of SI [2]. As the second cycle of PEPFAR broadens its focus to health systems strengthening in addition to scaling up services for HIV care treatment and prevention (PEPFAR I), the effective use of SI is key for this venture to be successful. A recent review of PEPFAR I by the Institute of Medicine (IOM) supports the role of SI in HIV-related activities. The IOM report recommended that as PEPFAR goes forward there is a need for quality data to guide interventions, evidence-based decision making, and ongoing evaluations and research [2].The Centers for Disease Control and Prevention (CDC) has extensive experience in teaching the use of data for effective decision making using an applied approach that entails hands on practical training [3-5]. The use of data is central for evidence-based decisions as it leads t
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